Anesth Anale 56 :831-835,1977
Ernst, Hoppel, Lorig, et a1
831
Operating Room Scheduling by Computer EDWARD A. ERNST, MD* CHARLES L. HOPPEL, B S t JUNE L. LORIG, BS, RNS ROBERT A. DANIELSON, MDS Cleveland, Ohio11
The surgical operating room schedule has been produced automatically for more than 2 years in our large teaching hospital. In order to apply computer technology to the complex surgical scheduling problem, a special pro g r a m m i n g approach was devised. We discuss this approach under the headings of Expand, Sort. Order and Assign. Consistent, reliable- schedules', unaffected
by weekends and holidays, are produced by a clerk trained to use a computer terminal. Our program is adaptable to other institutions once the scheduling parameters and operating priorities are delineated.
B
with the process; space and time utilization are often less than optimal, adding to the problem of inserting emergency cases into the elective schedule; and resulting schedules are frequently criticized as inefficient and unfair, creating discord among staff.
multiple factors of competing importance must be considered, production of an efficient elective surgical schedule is a complex task. Basically, the scheduling process must take into consideration service and surgeon priorities in preferred rooms, and availability of nurses and anesthesiologists. In addition, the surgical schedule must be sufficiently flexible to accommodate emergency cases. ECAUSE
Key Words-ANESTHES1A* scheduling.
We believe that on-line computer surgical scheduling resolves the problems outlined and provides an avenue for optimal patient care in this area. There are precedents for In most institutions, surgical schedules the use of a computer in scheduling patientare produced manually. In small hospitals related services. Nurse rotations have been this is performed by a single clerk and in scheduled by computer, programs have large teaching institutions by an interdisci- been devised for scheduling out-patient clinplinary team with representatives from sur- ic visits,2 and an operating room information gery, anesthesiology, and nursing. The man- system utilizing a computer has been deual scheduling process frequently breaks veloped.3 Furthermore, in the area of operdown in several critical areas: weekend ating room scheduling, a solution to the schedules are produced by those unfamiliar problem of anesthesiologist availability was *Associate Professor, Department of Anesthesiology. ?Software Manager, Information Services. toperating Room Supervisor, Nursing Service. $Assistant Professor, Department of Surgery. IlDepartment of Anesthesiology, Surgery, Nursing and Data Processing; Case Western Reserve University, Metropolitan General Hospital, and University Hospitals, Cleveland, Ohio. Supported in part by University Hospitals Grant ME-190. Address reprint requests to Edward A. Ernst, MD, Department of Anesthesiology, Cleveland Metropolitan General Hospital, Cleveland, Ohio 44109. Accepted for publication: May 11, 1977
832
Anesth Anala
Surgical Scheduling by Computer
proposed in 1973,4 and a program developed and implemented for on-line computer scheduling of anesthesiologists in 1974.5 This paper describes the structure and a method of implementation of an automated surgical scheduling system used daily in a large teaching hospital.
METHODS In order to apply computer technology to the complex surgical scheduling problem we developed a software program discussed under the headings Expand, Order, Sort and Assign (EOSA System; fig 1 ) . Expand.-The computer internally sets up an array which lists each surgical request in all rooms where the case could be performed. This array is then further expanded to consider each 15-minute time interval from the earliest time the surgeon is available. Frequently the expansion yields 100 listings for a single request, but it results in an efficient selection of room and start times. Expansion of requests is limited bv parameters listed in computer reference tables (see table). An Operating Room Information table lists preoperating rooms available, the surgical services allowed to use each room, and the earliest and latest start times for each room. A Procedure Information table lists rooms available for specialized procedures such as cystoscopy or angiography.
S o r t and A s s i g n
Tables
Program
Printing
and D i r t r ibut ion I
FIG1.
J
5 6 :831-835,1977
TABLE Reference Tables and Files Used by Computer Program to Expand and Order Each Surgical Request
Operating Room Information table Availability Priority order of services i n each operating room Earliest and latest start times Procedure Information table Operating rooms allowed f o r each procedure List of procedures by ICDA code Average degree of difficulty Surgical Service Information table Surgeon’s priority within each service Surgeon’s room preference
Order.-Next the computer determines an ordinal number for each request in the expanded array, using the reference tables again. An ordinal number determines the order of requests to be considered. A hypothetical ordinal number comprised of 4 parts (001 004 001 002) for a requested case in a particular room is shown in fig 2. The service priority is obtained from the Room Information table, and the Surgical Service Information table provides the surgeon’s priority and room preference. Category A in fig 2 indicates that the surgical service requesting this case has top priority in the room under consideration. Category B means that the case would be scheduled 1 hour (four 15-minute intervals) later than the surgeon requested. The surgeon represented in Category C has top priority over other surgeons within that service. Category D indicates that this surgical service prefers to operate in this room by 2nd choice. The sequence in which the categories appear determines their relative importance. Sort and Assign.-The computer assigns cases by highest priority, that is, by the A
0
C
D
Service priority
Time slot
Surgeon priority
Room preferred by service
001
004
001
002
FIG 2. Priority categories used to construct the ordinal number for operating room scheduling by computer.
Anesth Anala 56 :831-R35, 1377
Emst, Hoppel, Lorig, et a1
lowest ordinal number, and schedules cases to a particular room at a particular hour. The expanded requests in the array are deleted as each case assignment is made. The Procedure Information table is used again to determine the estimated start time for the next case to follow. Assignment of anesthesiologists to each case is done by using the previously reported on-line anesthesiologist scheduling program.5 The average degree of difficulty of each procedure obtained from the Procedure Information table helps in assigning resident anesthesiologists. Additional information concerning the computer program is given in the appendix.
IMPLEMENTATION Requests for Surgery.-Surgeons request cases to be scheduled on a simple printed worksheet. They are permitted to make entries until a specified time on the day prior to surgery. Figure 1 indicates that the request may also be made by telephone to a scheduling clerk. Information required to schedule a surgical case includes the patient’s name, proposed procedure, surgeon’s name, surgical service, and anesthetic preference. Other desired information includes the requested start time, patient’s hospital number, hospital division, and whether a pathologist, patient’s x-rays or blood are required in the operating room.
A scheduling clerk enters the surgical request information from the worksheets into the computer using a cathode ray tube (CRT) terminal. This program is designed simply so that new as well as weekend personnel can easily operate the system. The program also allows the scheduling clerk to enter information flags that will appear on the schedule to alert ancillary services of anticipated involvement in the case. The process is interactive, with an on-line teleprocessed program used by the admitting office to obtain patient’s hospital number, age, and sex. Even the accuracy of spelling a patient’s name may be clarified by using a program that lists all patients in the hospital with a name that “sounds like” the name under consideration. Reference Tables.-The Operating Room Committee determines the parameters that govern the scheduling system. These parameters, contained in the set of reference tables (see table) , must be changed periodically to meet operational needs. Programs have
833
been written to allow periodic changes in the content of the reference tables. After all requests are entered, the actual running time of the scheduling program, for 120 requests in 25 rooms including assignment of anesthesiologists, is less than 2 minutes on our IBM/370 158. A display on the CRT confirms that all cases are scheduled, or alternatively, displays a list of unscheduled cases. Scheduling failures may occur if incorrect ICDA (International Classification of Diseases, Adopted) numeric codes are assigned, if the surgeon lacks priority, or if a room assignment cannot accommodate a specific case. Provisions are made to enter, reassign, or delete a case after the automated schedule has been completed. On request, the screen displays the scheduled cases: the room assignment, start time, surgeon, and anesthesiologists. Any 2 operating rooms’ schedules can be displayed on the screen simultaneously for the entire day, allowing rapid review by the scheduling off icers. This permits flexibility in the scheduling system and allows for modifications when desirable. Emergency Additions, Cancellations, and Requested Time Changes.-If a surgeon or anesthesiologist wants to change the schedule, he must call the surgical desk, where the request is recorded in triplicate on a schedule change slip. These slips are immediately delivered to the operating room nursing supervisor and the anesthesia coordinator, who jointly make a judgment concerning the change. If the change is accepted and the time earlier than 1600 hours the day prior to surgery, it can be incorporated into the computer printout by manual override. Changes later than that or on the day of surgery must be handwritten on the master schedule posted in the operating room suite. When a time change is made, an emergency inserted into the elective schedule, or a case cancelled and the succeeding case advanced, it is the responsibility of the operating room nursing supervisor or her designee to immediately inform all surgeons and others affected by the change. The facilitation of some changes requires the cooperation of the involved surgeons and needs to be negotiated. Our computer scheduling system, unfortunately, does not alter this. Printing and Distributing the Schedule. -The approved schedule is printed by a
834
Surgical Scheduling by Computer
line printer in the operating suite. Each page of the final schedule is reduced to 11" x 8%" size by xerography, reproduced, collated and immediately delivered by pneumatic tube throughout the hospital.
DISCUSSION The automated scheduling system described in this report was designed after traditional methods of programming were found unsuitable. Linear programming is the fastest method; but the linear algebraic equations it requires were not suitable to describe the complex operation of the operating room. Recursive reforming methods assign operating rooms as they are requested, constantly reassigning for higher priority cases. This method was rejected because it requires excessive computer time during the peak utilization hours of the hospital's computer center. At this stage the EOSA programming method, a unique solution to the automated surgical scheduling problem, was developed. The advantages of the system have been gratifying. Consistently high-quality schedules have reduced discord among operating room personnel. The disgruntled surgeon or resident is quickly referred to the computer, sparing the badgered coordinator. Physicians and nurses are free to pursue clinical activities. The quality of the schedule is unaffected by weekend or holiday scheduling since entry programs are simply designed so that with minimal training on the CRT terminal anyone may operate the system. Reference tables permit a large degree of versatility, allowing for changes in operating room policies. Alterations of the tables in the batch mode minimizes on-line teleprocessed computer time, but allows the system to be on-line briefly for scheduling each afternoon. Operating room scheduling by computer is immediately adaptable to any operating room setting once specific priorities are defined. The EOSA concept permits the generation of a single ordinal priority number, containing an integer sequence, that can be rearranged to accommodate various operating-room scheduling policies. For instance, if it were decided that time was more important than surgical priority, Category B in fig 1would precede Category A. Such an arrangement might be tested for increase of overall operating room efficiency.
Aneath Anala 56 5331-835, 1977
Surgical scheduling information can be utilized to assist in generating the surgical log.6 Information appearing on the surgical schedule can be verified and updated to compose the computerized log, a valuable source of administrative and educational information. The costs of these benefits must be considered. In our institution the monthly rental and operational costs for computer, terminal, and printer are $800. An additional $250 is spent on paper, printing, collation, and distribution, bringing the total cost to over $1,000. We print 125 schedules of 10 pages each 20 times a month, bringing the approximate cost to 46 per page. Ten cases are printed on each page.
APPENDIX: DATA PROCESSING SYSTEM The operating room scheduling system runs on an IBM/370 158 computer using CICS. A VSAM file is used to hold all tables and requests. All programs are written in COBOL to take advantage of VSAM, CICS, and SORT. There are 5 major components in the system:
I. Enter Surgical Requests.-This component consists of 2 programs to allow the scheduling clerk to enter all requests through a 3270 terminal. Requests are stored by surgical date and may be entered for any future date. ZZ. Assignment.-This component consists of 2 programs which run upon notification that all requests have been entered. The 1st program assigns cases to rooms by the EOSA method described in the text using standard SORT facilities. The 2nd program assigns anesthesiologists to cases.5 Each program takes approximately 1 minute to run using 5 to 10 seconds of CPU time.
ZZZ. Schedule Revision.-Four CICS programs comprise this component. Two are used to review and modify the schedules using VSAM update facilities, and 2 are used to print the schedules on a 3284 printer terminal. ZV. Parameter Maintenance.-The parameter lists, stored in a VSAM file, are modified on-line by 4 programs. These modifications occur only with a major change in operating room usage, personnel, or procedure.
Anesth Analg 56 :831-835, 1977
Ernst, Hoppel, Lorig, et a1
835
V. Anesthesiologist Scheduling.5-NonREFERENCES operating-room activities of anesthesiolo1. Warner DM, Prawda J: A mathematical progists, including research, meetings, etc, are gramming model for scheduling nursing personnel entered and displayed by 3 on-line pro- in a hospital. Management Sci 19:411, 1972 grams. This phase is necessary to accom2. Cronkhite LW: Computers bring order to clinmodate the daily automated operating room ical scheduling system. Hospitals 43:55, 1969 assignment of anesthesiologists. 3. Moll DB, Laude MA, Buckly J J : O.R. information systems implemented hospitals. J A H A 40:55, Requests f o r additional programming in- 1975 formation may be sent to Mr. Charles M. 4. Ernst EA, Lasdon L, Ostrander LE: AnestheHoppel, Information Systems, 2065 Adel- siologists scheduling using a set partitioning algorithm. Comput Biomed Res 6:561, 1973 bert Road, Cleveland, Ohio 44106.
ACKNOWLEDGMENT The authors wish to thank Miss Sharon Lillevig for her assistance in editing and preparation of the manuscript.
5. Ernst EA, Matlak EW: On-line computer scheduling of anesthesiologists. Anesth Analg 56:854, 1974 6. Danielson RA, McClain KE, Lorig JL: Computerized surgical log information system. J Med Educ 49:290, 1974
A patient with congenital factor VII deficiency (factor VII level 12 percent of normal) had gynecologic surgery performed uneventfully without prophylactic bloodproduct replacement therapy. A review of 12 additional patients with factor VII deficiency who underwent surgery without replacement therapy showed t h a t surgical bleeding was uncommon and t h at there was no relationship between factor VII levels and hemorrhage. It is proposed t h at replacement therapy be available for use if required, but tha t its routine preopenative use is unnecessary in this disorder. ( Y o r k e A J , M a n t M J : F a c t o r V I I deficiency and s u r g e r y : is pre-operative replacement t h e r a p y necessary? J A M A 238 :424-425,1977)
Ernst, Hoppel, Lorig, et a1
831
Operating Room Scheduling by Computer EDWARD A. ERNST, MD* CHARLES L. HOPPEL, B S t JUNE L. LORIG, BS, RNS ROBERT A. DANIELSON, MDS Cleveland, Ohio11
The surgical operating room schedule has been produced automatically for more than 2 years in our large teaching hospital. In order to apply computer technology to the complex surgical scheduling problem, a special pro g r a m m i n g approach was devised. We discuss this approach under the headings of Expand, Sort. Order and Assign. Consistent, reliable- schedules', unaffected
by weekends and holidays, are produced by a clerk trained to use a computer terminal. Our program is adaptable to other institutions once the scheduling parameters and operating priorities are delineated.
B
with the process; space and time utilization are often less than optimal, adding to the problem of inserting emergency cases into the elective schedule; and resulting schedules are frequently criticized as inefficient and unfair, creating discord among staff.
multiple factors of competing importance must be considered, production of an efficient elective surgical schedule is a complex task. Basically, the scheduling process must take into consideration service and surgeon priorities in preferred rooms, and availability of nurses and anesthesiologists. In addition, the surgical schedule must be sufficiently flexible to accommodate emergency cases. ECAUSE
Key Words-ANESTHES1A* scheduling.
We believe that on-line computer surgical scheduling resolves the problems outlined and provides an avenue for optimal patient care in this area. There are precedents for In most institutions, surgical schedules the use of a computer in scheduling patientare produced manually. In small hospitals related services. Nurse rotations have been this is performed by a single clerk and in scheduled by computer, programs have large teaching institutions by an interdisci- been devised for scheduling out-patient clinplinary team with representatives from sur- ic visits,2 and an operating room information gery, anesthesiology, and nursing. The man- system utilizing a computer has been deual scheduling process frequently breaks veloped.3 Furthermore, in the area of operdown in several critical areas: weekend ating room scheduling, a solution to the schedules are produced by those unfamiliar problem of anesthesiologist availability was *Associate Professor, Department of Anesthesiology. ?Software Manager, Information Services. toperating Room Supervisor, Nursing Service. $Assistant Professor, Department of Surgery. IlDepartment of Anesthesiology, Surgery, Nursing and Data Processing; Case Western Reserve University, Metropolitan General Hospital, and University Hospitals, Cleveland, Ohio. Supported in part by University Hospitals Grant ME-190. Address reprint requests to Edward A. Ernst, MD, Department of Anesthesiology, Cleveland Metropolitan General Hospital, Cleveland, Ohio 44109. Accepted for publication: May 11, 1977
832
Anesth Anala
Surgical Scheduling by Computer
proposed in 1973,4 and a program developed and implemented for on-line computer scheduling of anesthesiologists in 1974.5 This paper describes the structure and a method of implementation of an automated surgical scheduling system used daily in a large teaching hospital.
METHODS In order to apply computer technology to the complex surgical scheduling problem we developed a software program discussed under the headings Expand, Order, Sort and Assign (EOSA System; fig 1 ) . Expand.-The computer internally sets up an array which lists each surgical request in all rooms where the case could be performed. This array is then further expanded to consider each 15-minute time interval from the earliest time the surgeon is available. Frequently the expansion yields 100 listings for a single request, but it results in an efficient selection of room and start times. Expansion of requests is limited bv parameters listed in computer reference tables (see table). An Operating Room Information table lists preoperating rooms available, the surgical services allowed to use each room, and the earliest and latest start times for each room. A Procedure Information table lists rooms available for specialized procedures such as cystoscopy or angiography.
S o r t and A s s i g n
Tables
Program
Printing
and D i r t r ibut ion I
FIG1.
J
5 6 :831-835,1977
TABLE Reference Tables and Files Used by Computer Program to Expand and Order Each Surgical Request
Operating Room Information table Availability Priority order of services i n each operating room Earliest and latest start times Procedure Information table Operating rooms allowed f o r each procedure List of procedures by ICDA code Average degree of difficulty Surgical Service Information table Surgeon’s priority within each service Surgeon’s room preference
Order.-Next the computer determines an ordinal number for each request in the expanded array, using the reference tables again. An ordinal number determines the order of requests to be considered. A hypothetical ordinal number comprised of 4 parts (001 004 001 002) for a requested case in a particular room is shown in fig 2. The service priority is obtained from the Room Information table, and the Surgical Service Information table provides the surgeon’s priority and room preference. Category A in fig 2 indicates that the surgical service requesting this case has top priority in the room under consideration. Category B means that the case would be scheduled 1 hour (four 15-minute intervals) later than the surgeon requested. The surgeon represented in Category C has top priority over other surgeons within that service. Category D indicates that this surgical service prefers to operate in this room by 2nd choice. The sequence in which the categories appear determines their relative importance. Sort and Assign.-The computer assigns cases by highest priority, that is, by the A
0
C
D
Service priority
Time slot
Surgeon priority
Room preferred by service
001
004
001
002
FIG 2. Priority categories used to construct the ordinal number for operating room scheduling by computer.
Anesth Anala 56 :831-R35, 1377
Emst, Hoppel, Lorig, et a1
lowest ordinal number, and schedules cases to a particular room at a particular hour. The expanded requests in the array are deleted as each case assignment is made. The Procedure Information table is used again to determine the estimated start time for the next case to follow. Assignment of anesthesiologists to each case is done by using the previously reported on-line anesthesiologist scheduling program.5 The average degree of difficulty of each procedure obtained from the Procedure Information table helps in assigning resident anesthesiologists. Additional information concerning the computer program is given in the appendix.
IMPLEMENTATION Requests for Surgery.-Surgeons request cases to be scheduled on a simple printed worksheet. They are permitted to make entries until a specified time on the day prior to surgery. Figure 1 indicates that the request may also be made by telephone to a scheduling clerk. Information required to schedule a surgical case includes the patient’s name, proposed procedure, surgeon’s name, surgical service, and anesthetic preference. Other desired information includes the requested start time, patient’s hospital number, hospital division, and whether a pathologist, patient’s x-rays or blood are required in the operating room.
A scheduling clerk enters the surgical request information from the worksheets into the computer using a cathode ray tube (CRT) terminal. This program is designed simply so that new as well as weekend personnel can easily operate the system. The program also allows the scheduling clerk to enter information flags that will appear on the schedule to alert ancillary services of anticipated involvement in the case. The process is interactive, with an on-line teleprocessed program used by the admitting office to obtain patient’s hospital number, age, and sex. Even the accuracy of spelling a patient’s name may be clarified by using a program that lists all patients in the hospital with a name that “sounds like” the name under consideration. Reference Tables.-The Operating Room Committee determines the parameters that govern the scheduling system. These parameters, contained in the set of reference tables (see table) , must be changed periodically to meet operational needs. Programs have
833
been written to allow periodic changes in the content of the reference tables. After all requests are entered, the actual running time of the scheduling program, for 120 requests in 25 rooms including assignment of anesthesiologists, is less than 2 minutes on our IBM/370 158. A display on the CRT confirms that all cases are scheduled, or alternatively, displays a list of unscheduled cases. Scheduling failures may occur if incorrect ICDA (International Classification of Diseases, Adopted) numeric codes are assigned, if the surgeon lacks priority, or if a room assignment cannot accommodate a specific case. Provisions are made to enter, reassign, or delete a case after the automated schedule has been completed. On request, the screen displays the scheduled cases: the room assignment, start time, surgeon, and anesthesiologists. Any 2 operating rooms’ schedules can be displayed on the screen simultaneously for the entire day, allowing rapid review by the scheduling off icers. This permits flexibility in the scheduling system and allows for modifications when desirable. Emergency Additions, Cancellations, and Requested Time Changes.-If a surgeon or anesthesiologist wants to change the schedule, he must call the surgical desk, where the request is recorded in triplicate on a schedule change slip. These slips are immediately delivered to the operating room nursing supervisor and the anesthesia coordinator, who jointly make a judgment concerning the change. If the change is accepted and the time earlier than 1600 hours the day prior to surgery, it can be incorporated into the computer printout by manual override. Changes later than that or on the day of surgery must be handwritten on the master schedule posted in the operating room suite. When a time change is made, an emergency inserted into the elective schedule, or a case cancelled and the succeeding case advanced, it is the responsibility of the operating room nursing supervisor or her designee to immediately inform all surgeons and others affected by the change. The facilitation of some changes requires the cooperation of the involved surgeons and needs to be negotiated. Our computer scheduling system, unfortunately, does not alter this. Printing and Distributing the Schedule. -The approved schedule is printed by a
834
Surgical Scheduling by Computer
line printer in the operating suite. Each page of the final schedule is reduced to 11" x 8%" size by xerography, reproduced, collated and immediately delivered by pneumatic tube throughout the hospital.
DISCUSSION The automated scheduling system described in this report was designed after traditional methods of programming were found unsuitable. Linear programming is the fastest method; but the linear algebraic equations it requires were not suitable to describe the complex operation of the operating room. Recursive reforming methods assign operating rooms as they are requested, constantly reassigning for higher priority cases. This method was rejected because it requires excessive computer time during the peak utilization hours of the hospital's computer center. At this stage the EOSA programming method, a unique solution to the automated surgical scheduling problem, was developed. The advantages of the system have been gratifying. Consistently high-quality schedules have reduced discord among operating room personnel. The disgruntled surgeon or resident is quickly referred to the computer, sparing the badgered coordinator. Physicians and nurses are free to pursue clinical activities. The quality of the schedule is unaffected by weekend or holiday scheduling since entry programs are simply designed so that with minimal training on the CRT terminal anyone may operate the system. Reference tables permit a large degree of versatility, allowing for changes in operating room policies. Alterations of the tables in the batch mode minimizes on-line teleprocessed computer time, but allows the system to be on-line briefly for scheduling each afternoon. Operating room scheduling by computer is immediately adaptable to any operating room setting once specific priorities are defined. The EOSA concept permits the generation of a single ordinal priority number, containing an integer sequence, that can be rearranged to accommodate various operating-room scheduling policies. For instance, if it were decided that time was more important than surgical priority, Category B in fig 1would precede Category A. Such an arrangement might be tested for increase of overall operating room efficiency.
Aneath Anala 56 5331-835, 1977
Surgical scheduling information can be utilized to assist in generating the surgical log.6 Information appearing on the surgical schedule can be verified and updated to compose the computerized log, a valuable source of administrative and educational information. The costs of these benefits must be considered. In our institution the monthly rental and operational costs for computer, terminal, and printer are $800. An additional $250 is spent on paper, printing, collation, and distribution, bringing the total cost to over $1,000. We print 125 schedules of 10 pages each 20 times a month, bringing the approximate cost to 46 per page. Ten cases are printed on each page.
APPENDIX: DATA PROCESSING SYSTEM The operating room scheduling system runs on an IBM/370 158 computer using CICS. A VSAM file is used to hold all tables and requests. All programs are written in COBOL to take advantage of VSAM, CICS, and SORT. There are 5 major components in the system:
I. Enter Surgical Requests.-This component consists of 2 programs to allow the scheduling clerk to enter all requests through a 3270 terminal. Requests are stored by surgical date and may be entered for any future date. ZZ. Assignment.-This component consists of 2 programs which run upon notification that all requests have been entered. The 1st program assigns cases to rooms by the EOSA method described in the text using standard SORT facilities. The 2nd program assigns anesthesiologists to cases.5 Each program takes approximately 1 minute to run using 5 to 10 seconds of CPU time.
ZZZ. Schedule Revision.-Four CICS programs comprise this component. Two are used to review and modify the schedules using VSAM update facilities, and 2 are used to print the schedules on a 3284 printer terminal. ZV. Parameter Maintenance.-The parameter lists, stored in a VSAM file, are modified on-line by 4 programs. These modifications occur only with a major change in operating room usage, personnel, or procedure.
Anesth Analg 56 :831-835, 1977
Ernst, Hoppel, Lorig, et a1
835
V. Anesthesiologist Scheduling.5-NonREFERENCES operating-room activities of anesthesiolo1. Warner DM, Prawda J: A mathematical progists, including research, meetings, etc, are gramming model for scheduling nursing personnel entered and displayed by 3 on-line pro- in a hospital. Management Sci 19:411, 1972 grams. This phase is necessary to accom2. Cronkhite LW: Computers bring order to clinmodate the daily automated operating room ical scheduling system. Hospitals 43:55, 1969 assignment of anesthesiologists. 3. Moll DB, Laude MA, Buckly J J : O.R. information systems implemented hospitals. J A H A 40:55, Requests f o r additional programming in- 1975 formation may be sent to Mr. Charles M. 4. Ernst EA, Lasdon L, Ostrander LE: AnestheHoppel, Information Systems, 2065 Adel- siologists scheduling using a set partitioning algorithm. Comput Biomed Res 6:561, 1973 bert Road, Cleveland, Ohio 44106.
ACKNOWLEDGMENT The authors wish to thank Miss Sharon Lillevig for her assistance in editing and preparation of the manuscript.
5. Ernst EA, Matlak EW: On-line computer scheduling of anesthesiologists. Anesth Analg 56:854, 1974 6. Danielson RA, McClain KE, Lorig JL: Computerized surgical log information system. J Med Educ 49:290, 1974
A patient with congenital factor VII deficiency (factor VII level 12 percent of normal) had gynecologic surgery performed uneventfully without prophylactic bloodproduct replacement therapy. A review of 12 additional patients with factor VII deficiency who underwent surgery without replacement therapy showed t h a t surgical bleeding was uncommon and t h at there was no relationship between factor VII levels and hemorrhage. It is proposed t h at replacement therapy be available for use if required, but tha t its routine preopenative use is unnecessary in this disorder. ( Y o r k e A J , M a n t M J : F a c t o r V I I deficiency and s u r g e r y : is pre-operative replacement t h e r a p y necessary? J A M A 238 :424-425,1977)
